Crash section

I had been on a set of night shifts this past week.

Tuesday night was particularly stressful.

That evening, I arrived at work as the 2nd on call anaesthetist, half expecting to have a quiet 12 hours covering for any gynaecology emergencies that needed to go to theatre overnight. However, there was a haemodynamically unstable patient with a massive post partum haemorrhage in obstetric theatres. And so, I attended to give the 1st on call a hand in resuscitating this patient whilst the surgeons proceeded to perform a life-saving, haemorrhage-halting hysterectomy.

As I was busying myself checking blood products for this bleeding patient, one of the obstetric registrars burst in from the scrub room, completely gowned, gloved and masked up, shouting out “Who’s gassing my patient next door?!” Apparently there was a patient with placental abruption and a severely compromised fetus needing a category 1 crash caesarean section as well. A second emergency theatre had to be opened up, but they managed to inform everybody but the anaesthetists.

By the time I dashed next door, the woman was already on the table holding her own face mask and preoxygenating herself. The scrub nurse had already laid out all her instruments and the midwife was catheterising the patient. The surgeons were all scrubbed up and waiting expectantly with their scalpels. And me? I had NOTHING ready to anaesthetise the patient at all. The emergency drugs that are normally on stand-by had obviously all been used on the lady with the massive bleed. I didn’t even know this patient’s name or had a chance to do a pre-op assessment at all! What made things worse was the fact that the lady on the table was obese and pregnant- making her the perfect nightmare for difficult intubation and rapid hypoxia. And the worst bit? I was on my own- the only other anaesthetist in the hospital was the one next door, and she would most certainly not be leaving her unstable patient unattended on the table to bail me out if I run into any trouble.

My adrenals were working overtime then, and I had a heck of an adrenaline surge. I got my drugs ready (trembling hands all inclusive), performed a brief assessment lasting all of 20 seconds, got the patient to take a few vital capacity breaths, ran through the difficult intubation algorithm in my mind, muttered a quick prayer, and then performed my rapid sequence induction. Before I could even attempt to intubate the patient, the obstetricians had started painting the patient with skin prep and begun applying their drapes. They had their scalpels ready, waiting for me to give the go ahead to start. I had a look with my laryngoscope, and initially struggled to get the patient’s tongue out of the way to get a good view of the vocal cords. And then, I saw epiglottis. And with an upward lift of my laryngoscope, I saw the black hole into which I knew my endotracheal tube needed to go. You would not believe the relief I felt when the airway was secured, and when the surgeons pulled a live baby out in the next minute.

The tension in theatre certainly eased up after that, and I composed myself to administer all the other drugs she needed intraoperatively, watch the anaesthetic and catch up on my record keeping. Thankfully, everything went on without a glitch thereafter and the patient was safely extubated at the end, and returned to the recovery area feeling quite comfortable.

Due to the fact that most women coming for caesarean sections usually have a spinal anaesthetic, I have only ever given a GA for emergency caesarean section one other time (and I had a registrar giving me a hand then). And so, this particular episode of “flying solo” was particularly stressful. But I knew what I had to do, and I did what I needed to do, and more importantly, my patient was safe and the baby was alive.

I feel like I’ve taken a small little step forward in my journey as an anaesthetist.

Hopefully, the next step I take won’t be half as nerve wrecking as this one.

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